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can regulate the weather. She requires much personal attention.

September 1st. The patient developed pneumonia of the upper lobe of the left lung, with a temperature of 104 F.

September 5th. She was convalescent from the pneumonia and began to gain in physical strength.

September 24th. She was in fair bodily health, was quiet and agreeable, though at times she was found crying very piteously. On account of her inability to speak English, except very imperfectly, it was very difficult to ascertain the character of her delusions.

October 17th. Her physical health was excellent. She had become quite fleshy; exercised good self-control, and employed herself usefully at times, though she was still under the force of distressing delusions, and feared that she was to be killed or forced to work and not be permitted to go to her own home again.

November 17th. She had no delusions which could be discovered, and frequently requested to be allowed to go to her home. Had gained about thirty pounds in flesh.

December 16th. She was reported as fully recovered.

CASE 3.—The third case to which attention is called presents other elements of atiology, and is interesting as it illustrates what has been stated in reference to the intimate connection the insanity of one period may sustain to that of another. Her first attack occurred during pregnancy.

P. C., aged thirty-five, English, married, and of good heredity; has always been of correct habits, industrious, and of previous good health. She had exhibited symptoms of insanity, however, about four months prior to the birth of her second child, but they were of short duration. After the labor she improved rapidly.

The present attack dates back to about a year agopreviously to the birth of the youngest child. She became very emotional and would laugh immoderately and then suddenly cry. She has often made threats of violence, but never any attempt to execute them. Her sleep has been scant, but her appetite almost voracious. She has complained of starving, although an abundance of food has been provided for her. She has destroyed her furniture and clothing, and would not keep herself tidy nor allow others to.

January 5th. The patient entered the Institution in a broken down state of physical health, having recently experienced an abortion. She was very feeble both in mind and body; had no well-defined delusions. She suffered considerably from hemorrhages from the uterus, subsequently to the abortion. During the next two months the uterine trouble was corrected and she improved steadily afterward. She became pleasant and very industrious, but had delusions concerning her social standing, and also about her hus. band.

Three months later, the patient became depressed and rather irritable. Her delusions became very active and did not change in character. Her physical health was well maintained.

September 22d. The patient stated to-day that she was born and bred a lady, and demanded apartments and servants suitable for her supposed condition of life. She complains of the noise and imagined ill-treatment she receives at the hands of her fellow-patients, but is quite noisy herself. She does not seem to recognize that fact. She blames her husband for keeping her here. December 16th. For the last month the patient has been very comfortable. Her delusions, if they exist, are dormant, and she makes herself quite agreeable. She is industrious, tidy, and quite sociable, attends dances, parties, and other amusements, and is, apparently, making a very good recovery.

LECTURE XIX.

INSANITY OF THE PUERPERAL PERION,

(CONCLUDED.)

Treatment of Puerperal Insanity, Local and General— Insanity of Lactation

Ætiology-Period of Lactation—Intluence of Prolonged Lactation -
Modes of Living-Accidents and Complications at Time of Labor-
Effects Cpon the Blood and Nervous System-Symptoms--Suspicion--
Depression- Morbid Impulses-Sexual Excitement - Hallucinations-
Physical Condition—Tables of Cases at the Retreat and the Connecticut
Hospital — Illustrative Case—Prognosis Generally Favorable-Of Fifty
four Cases, Thirty-nine Recovered— Treatment.

Treatment. This is of great importance in all cases and especially in those which depend upon abnormal conditions existing in the uterus and its appendages. Examination should be made at the earliest practical opportunity, with the purpose of ascertaining what injury, if any, may have occurred to the neck or to the external parts, and also for the purpose of determining whether the involution of the uterus has been properly consummated, or if it is in the way of becoming so. If the lochia are of a fætid character, warm and soothing lotions and injections should be used and the vaginal passage properly cleansed. In case the temperature is high, small doses of aconite may be given hourly, and saline mixtures given with a view of securing one or more evacuations from the bowels. Special attention should be given to the condition of the breasts, and the milk should be removed by a breast pump.

Warm fomentations and rubbing may also be used to prevent the formation of abscesses. Simple and nourishing food should be given osten, and, if necessary, should be administered with a tube. Sleep is of special importance in the treatment of this form of insanity. It may usually be secured more surely by a 15- or 20-grain dose of chloral than by any other hypnotic. When this is contraindicated for any reason sulsonal or chloramid may be used with advantage. In some cases the bromide of sodium with cannabis indica has proved to be efficient in securing several hours of sleep each night. In those cases in which the blood is much impoverished cod-liver oil and cream or rich milk, with wine, may be given after the more active symptoms have passed away.

Iron in some form, either alone or combined with strychnia, may be used with good results. In fact, iron is more often beneficial during the latter stage of puerperal insanity than in many other forms.

Care should be taken from the first to secure movements from the bowels by the administration of the most simple laxatives or by the use of suppositories. It is very important to secure frequent changes in the air of the rooms occupied by the patient and also to have several hours of sunshine in the room. As soon as practicable the patient should be taken from the house and into the open air every pleasant day, where she should pass several hours with her attendant if the temperature is such as to warrant it. Improvement in the physical condition is, in the large majority of cases, attended with improvement in the mental states.

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